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The pterional approach and anterior interhemispheric approach are both valid surgical routes for the treatment of anterior skull base meningiomas. Comparative studies of these two surgical routes are not yet reported in the literature.

Case report and literature review.

Cerebral abscess following cholesteatomatous otomastoiditis is a life-threatening complication and poses diagnostic and therapeutic challenges. We report a case of life-threatening cerebritis and cerebral abscess due to a collection of pus from an aerobic super infections occurring months after the apparent resolution of an otogenic brain abscess in a 67-year-old immunocompetent Italian female. Two gram-positive anaerobic pathogens were isolated during secondary neurosurgical procedures and antibiotic treatment was adopted to resolve the complications. Another objective of this study was to review the literature on gram-positive anaerobic pathogens and brain abscess complications in patients with fistula, and to highlight the importance of short imaging in monitoring treatment during long-term antibiotic therapy for otogenic brain abscess to avoid abscess recurrence. Isolating the strain and monitoring response to treatment with magnetic resonance imaging may improve the prognosis. The study also highlights the need for a close cooperation between infectious disease consultants and neurosurgeons.

The most frequent complications after shunt surgery are infective and obstructive. Other types are less common, and eventually occur due to technical errors during brain ventricular puncture, opening the intraperitoneal cavity or the tunnelling of the catheter between the two points. Although rare, there are well-reported complications related to the poor positioning of the distal catheter, with perforation of organs and tissues.

Basal cell carcinoma (BCC) is a non melanocytic skin cancer that arises from basal cells, affecting commonly fair-skinned human beings. Although the tumor is well known for local recurrences, extension into the intracranial space is reported. A case of a giant BCC of the scalp invading the middle and posterior third of the superior sagittal sinus (SSS) is reported. A 70-year-old male with a basal cell carcinoma history presented with a massive bleeding from the SSS invaded by the tumor. Since the patient refused surgery the bleeding was managed through direct compression by applying a thrombin-based hemostatic agents and sterile dressings. This procedure was performed daily in order to stimulate the spontaneous thrombosis of the dural sinus and development of collateral circle. BCC invading the SSS is rarely reported. A technical description of this case is provided. This case underscores the importance of early and appropriate treatment for high risk BCC, and whenever surgical procedure is not suitable appropriate conservative treatment may be efficacious.

The management of ruptured intracranial false aneurysms (IFAs) might be tricky as any kind of treatment modality, surgical or endovascular, is burdened with significant challenges. A case report of the endovascular treatment of IFA in emergency setting is presented to provide more understanding of its pathophysiology as well as of the best operative work-up for petrous carotid artery reconstruction.

Case report and review of literature.

Skull reconstructive surgery is critical to prevent cerebrospinal fluid (CSF) fistulas and infections, and to ensure good aesthetic results in meningiomas surgery.

Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a “sit back, wait and see” approach may represent the safest and most reasonable option.

•Metaplastic meningiomas are rare entities, and intracranial osseous subtype are even more rare.•Gross total resection is considered the best treatment choice.•Differential diagnosis is mandatory, including osteoma, osteoblastoma, and calcified giant aneurysms.•This rare entity must be considered in a global approach and tailored surgical technique.

Marburg's disease (MD) is an extremely rare and aggressive form of multiple sclerosis (MS). In some cases, MD presents with tumefactive demyelinating lesions with a “tumor-like” appearance in MRI images, for which it may be difficult to achieve a form of differential diagnosis between definitive tumors or abscesses. Here we report a case of MD histopathologically confirmed after neuronavigationguided biopsy. Postoperative course was uneventful and following discharge, the patient attended outpatient follow-up appointments and received i.v. cyclophopsphamide, achieving progressive clinical remission. A nine-month follow-up brain MRI scan with gadolinium showed no signs of progressing demyelinating disease with an evident reduction of the biopsied lesion, and almost complete retrogression of the other two lesions.